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Take-up of the NHS' Choose and Book system by GPs is off to an extremely slow start.

A report by the membership magazine of the British Medical Association, BMA News says only 67,820 referrals have been made by GPs in England out of an estimated yearly total of 10 million.

The figures are from data collected by the Department of Health (DoH) from Strategic Health Authorities (SHA) across England by December 23, 2005.

They indicate that "Choose and Book had barely registered in some parts of the country" and even when patients are offered a menu of choices for booking treatment, it is still being done manually.

The Counties of Bedfordshire and Hertfordshire registered a combined 46 referrals before Christmas. This compares with figures of 288 in Cumbria and Lancashire, and 374 in Essex.

Efforts by the DoH to boost usage of Choose and Book have seemingly had little effect. NHS director of access Margaret Edwards wrote to all SHA chief executives over a year ago calling for them to push Choose and Book as the primary channel, "in preference" to interim manual solutions.

Financial incentives have also had minimal impact. Primary Care Trusts were offered £100,000 if they could demonstrate that 50 per cent of its GP referrals had been made through Choose and Book by October 2005. Durham Dales was the only successful PCT.

GPs have also experienced delays in making the referrals with one Liverpool GP taking 57 minutes to refer three patients.

According to Bedfordshire and Hertfordshire LMCs Chief Executive Peter Graves many GPs are ambivalent about Choose and Book, saying that "it has barely registered."

Choose and Book is a service that for the first time offers doctors and patients the opportunity to choose which hospitals they are referred to and to select convenient appointment times. It is one of the key systems that will help the government deliver its patient choice agenda.

The latest implementation goal is for 90 per cent of GP referral to be made through the system by March 2007.